Blepharoplasty, Repair of Blepharoptosis, and Brow Ptosis Repair

By July 15, 2026: Billing team must implement the following changes: (1) Update billing system to flag all blepharoplasty and ptosis repair claims (CPT 15820-15823, 67900-67911, 67916-67917, 67923-67924, 67950, 67999) for prior authorization review; (2) Create a documentation checklist requiring providers to submit visual field testing results (superior visual field ≤20 degrees baseline, ≥12 degree improvement with taping), color photographs in pupillary plane with straight gaze, and clinical documentation ruling out unstable conditions (myasthenia gravis, thyroid disease); (3) Reject claims for more than one surgical session for these procedures; (4) Reject all lower lid blepharoplasty claims for excessive skin alone; (5) Flag brow ptosis repairs (CPT 67900) to ensure eyebrow position documentation below supraorbital rim; (6) Train providers and front desk staff to inform patients BEFORE rendering services that procedures not meeting criteria are cosmetic and patient responsibility; (7) Update denial letters to cite specific unmet criteria from policy section I or II. Without these system updates, inappropriate claims will be paid and cosmetic procedures may be incorrectly covered.